Neurocognitive testing to predict ICANS post-CAR T.
Notice bibliographique
Résumé
e19003 Background: Since the approvals of chimeric antigen receptor T-cell (CAR T) therapy in acute lymphoblastic leukemia (ALL), non-Hodgkin lymphoma (NHL), and multiple myeloma (MM), it has been increasingly offered in centers nationwide. Immune effector cell-associated neurotoxicity syndrome (ICANS) poses a potentially fatal risk with CAR-T. Identifying patients at risk of having high grade ICANS is a thus a priority. Scoring systems such as the EASIX scores have accounted for disease and comorbidity factors but haven’t addressed neurocognitive function. The St. Louis University Mental Status (SLUMS) Exam and the Montreal Cognitive Assessment (MoCA) have not been examined for validity and reliability in this population, so we performed a retrospective review of CAR T patients at the University of Kansas Medical Center to identify if incidence or severity of ICANS could be correlated with neurocognitive testing performed in the pre-infusion period. Methods: Patients receiving CAR T targeting CD19 or BCMA between December 2017 and December 2023 were included. Neurocognitive testing was performed by trained onco-psychology, neurology, or hematology-oncology staff. The SLUMS exam is an 11 question exam scored on a 30 point scale to predict normal neurocognitive function (27-30 points), mild neurocognitive disorders (21-26 points), and dementia (0-20 points). The MoCA is an 11 question exam scored on a 30 point scale to predict normal cognition (26-30 points), mild cognitive impairment (18-25 points), moderate cognitive impairment (10-17 points), and severe cognitive impairment (<10 points). Incidence of ICANS and severity of ICANS were compared between patients who had any detected cognitive dysfunction and those who had none, as well as between the tiered result system unique to each test. Results: We included 360 patients in this analysis, (257 NHL, 84 MM and 19 ALL) leading to comparisons of 276 CD19-directed CAR T patients and 84 BCMA-directed CAR T patients. In CD19-directed patients, there were no differences in ICANS incidence according to the SLUMS scores. There was a significant increase in ICANS incidence for patients who had a positive MoCA exam, p=0.006. Additionally, ICANS incidence was correlated with more severe MoCA results, p=0.01. No differences in ICANS severity were observed using any neurocognitive test. In BCMA-directed patients, no differences in ICANS were observed using the SLUMS or MoCA. Conclusions: Our results suggest that while the SLUMS exam does not predict ICANS, the MoCA may independently predict incidence of ICANS. Patients with a higher score correlating with normal cognition are less likely to develop ICANS and may be appropriate for outpatient therapy. For those with lower scores correlating with more severe neurocognitive disorders, inpatient monitoring and early intervention will continue to be important.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».